# Are self-management skills associated with depressive symptoms, quality of life, and healthcare utilisation? A cross-sectional survey among patients with advanced cancer in the Netherlands

## TL;DR

This study explores how self-management skills in advanced cancer patients relate to depression, quality of life, and healthcare use in the Netherlands.

## Contribution

The study provides new evidence on the relationship between self-management skills and mental health outcomes in advanced cancer patients.

## Key findings

- Higher self-management skills were linked to fewer depressive symptoms in advanced cancer patients.
- Better self-management skills correlated with improved quality of life.
- Self-management skills had minimal impact on healthcare utilization.

## Abstract

Patients with advanced cancer are increasingly encouraged to self-manage the medical, psychosocial, and practical consequences of their illness. However, the impact of self-management skills on patient outcomes and healthcare utilisation remains unclear. Therefore, we examined self-management skills among patients with advanced cancer and their associations with depressive symptoms, quality of life, and formal and informal healthcare utilisation.

We embedded a cross-sectional questionnaire study in a Dutch nationwide prospective observational cohort study (eQuiPe study).

464 patients with advanced cancer (response rate 42.1%). 50% of the participants were women, and the mean age was 66 years (SD = 10).

Self-management skills were assessed using three scales of the Health Education Impact Questionnaire: Skill and technique acquisition (STA), Self-monitoring and insight (SMI), and Health services navigation (HSN) (range: 1–4). Multivariate linear and logistic regression analyses were performed to examine associations (adjusting for sociodemographic and medical characteristics) between self-management skills and depressive symptoms (Hospital Anxiety and Depression Scale), quality of life (European Organisation for Research and Treatment of Cancer), and healthcare utilisation in the past month (healthcare organisations and disciplines; hospital admissions; emergency care visits; informal care).

Mean (SD) scores were 3.0 (0.5) for STA, 3.2 (0.4) for SMI, and 3.4 (0.5) for HSN. Higher scores of self-management skills on all three scales were significantly associated with fewer depressive symptoms (STA: β = −2.36, 95% CI −2.98 to −1.69; SMI: β = −2.88, 95% CI −3.64 to −2.09; HSN: β = −2.06, 95% CI −2.76 to −1.37). Patients with higher levels of STA and SMI reported better quality of life (β = 8.54, 95% CI 5.84 to 11.01 and β = 8.41, 95% CI 4.75 to 11.99, respectively). Regarding healthcare utilisation, only HSN showed a significant association, with higher scores being associated with increased nurse contact (β = 1.65, 95% CI 1.09 to 2.56).

Greater self-management skills were associated with fewer depressive symptoms and improved quality of life in patients with advanced cancer. However, self-management skills were hardly associated with healthcare utilisation.

Netherlands Trial Register; NTR6584.